A DEPARTMENT OF EPIDEMIOLOGY N & PREVENTIVE MEDICINE … · The Department of Epidemiology and...

DEPARTMENT OF EPIDEMIOLOGY

& PREVENTIVE MEDICINE

ANNUAL

REPORT

2001

About the department

The Department of Epidemiology and Preventive Medicine (DEPM) was established in1969 at the Monash University Medical School - Alfred Hospital, and is now located at553 St Kilda Road, Melbourne, with easy access to Monash Medical School and theAlfred Hospital.

DEPM continues to play a prominent role in public health medicine in Australia. Thecore skills of the department relate to epidemiology (the study of the distribution, riskfactors and causes of disease) and its application to problems in clinical medicine andpublic health.

A number of trends in public health and health care funding have led to an increaseddemand for these specialist skills. These trends include an emphasis on appliedclinical research to provide evidence of effectiveness of medical interventions; a rapidincrease in provision of health related data driven by the need for financial accountabilityand quality assurance; a growing emphasis and financial incentives for prevention ofillness; an increased focus on measuring the quality of health care; and an increasedconcern about legal liability which requires identification of long term hazards of medicalinterventions.

Financial support for research in DEPM is drawn from a variety of State and FederalGovernment bodies, private companies and charitable organisations primarily in theform of competitive grants. DEPM ranks among the most successful Monash Universitydepartments in attracting external research funding. We also undertake contractresearch and consultancies for a wide range of industry bodies and governmentdepartments, and are partners in the Australian Government Cooperative ResearchCentre Program.

We have an extensive teaching program including undergraduate medical andbiomedical science degrees, postgraduate courses including the Master of PublicHealth, a range of Diplomas and Certificates, and several short courses.

We also provide high quality PhD research training to graduates from a broad spectrumof medical and non-medical backgrounds. Epidemiology (together with Biostatistics)is the key scientific discipline underlying some of the most important and rapidlydeveloping areas in medicine, and our PhD graduates are equipped with core skillswhich form the basis for a successful future career in a range of fields.

How to find us

The Department is located conveniently close to The Alfred Hospitaland is easily accessible by public transport from the city.

Trams run from Flinders Street Station south along St Kilda Road -numbers 3, 5, 6, 16, 64, 67 to Moubray Street. Trains run from FlindersStreet to Prahran Station (Sandringham line), with just a short walk toSt Kilda Road. We are on Melway map 58, 2L B9 and metered carparking is available on St Kilda Road or Moubray Street.

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ALFRED HOSPITAL

St K

ilda Road

Commercial Road

Moubray St Greville Street

Prahran Railway Station(Sandringhqam Line from

Flinders Street)

To Melbourne

DEPM is here

General enquiriesPhone +61 3 9903 0555Fax +61 3 9903 0556

Address mail toThe Department of Epidemiology & Preventive MedicineCentral & Eastern Clinical School, Alfred HospitalCommercial Road, Melbourne 3004Victoria, Australia

Deliveries3rd floor 553 St Kilda RoadMelbourne

Ashley Ricketson Centre260-294 Kooyong RoadCaulfield

Head of DepartmentProfessor John McNeilPhone +61 3 9903 0565Fax +61 3 9903 [email protected]

Postgraduate course informationPhone +61 3 9903 [email protected]

Short course informationPhone +61 3 9903 [email protected]

Biostatistical Consulting ServicePhone +61 3 9903 [email protected]

Contact details for individual research units can be found on the page for that unit.

Visit our website at www.med.monash.edu.au/epidemiology

How to contact us

DEPM became a partner in the newly established Australian Centre for Human Health Risk Assessment(ACHHRA), a consortium of Monash University, University of Queensland, Griffith University and FlindersUniversity. The centre will address research, training and advisory needs resulting from health risks inAustralia, with an emphasis on the health impact of environmental hazards, and is funded by the PublicHealth Education and Research Program. The Director of ACHHRA will be based in DEPM.

In January, the Federal Government announced it would provide $16.7 million over seven years to fundAustralia’s National Drinking Water Research Organisation, the Cooperative Research Centre for WaterQuality and Treatment, until 2008. DEPM is a partner in the CRC, a joint venture between thirtyparticipants from industry, research and governments from every State and Territory in Australia. InFebruary, John McNeil and Martha Sinclair attended a planning meeting of the new ManagementCommittee in Adelaide.

Brent Robertson, a PhD student in DEPM, won the 2001 GJ Rouch Prize awarded by the VictorianBranch of the Australasian Faculty of Public Health. The prize is awarded annually to the advancedtraining candidate in public health medicine who gives the best presentation of research work at ameeting of the Faculty. Brent presented his PhD work on “Case-control studies of sporadiccryptosporidiosis in Melbourne and Adelaide”.

In October, the Department was visited by the Honorable Minister of Health for Indonesia, Dr AchmadSujudi; the Director General of Medical Care, Prof Dr HMusjtahid Achmad Djojosugiti, Mr Jafar Husein, Dept ofForeign Affairs, Jakarta, and Mr Ryadi Asirdin, the IndonesianConsulate General, Melbourne. DEPM has been involved intraining Indonesian Master of Health Services Managementstudents over the past couple ofyears under an AsianDevelopment Bank contract and we look forward to continuingour educational involvement with Indonesia. Prof Dr Djojosugitialso visited the Department in June, with Dr IGPWiadnyana,Project Manager for the Asian Development BankIII Project, Dr Kuswartini, Head of Personnel, and A/Prof PhilipStokoe.

The Department was admitted as a Board Member to the Asian Pacific Academic Consortium for PublicHealth, which has representatives from seventeen countries in the Asia-Pacific region with the aim topromote public health in the region. Malcolm Sim attended a Board meeting in Seoul in April.

A/Prof Rachelle Buchbinder, along with colleagues Dr Damien Jolley and Dr Mary Wyatt, were awardedthe Volvo Award for their evaluation of the Victorian WorkCover Authority Public Health Campaign aboutback pain. This prestigious annual award in the area of spinal research is awarded by the Volvo Companyof Sweden. Rachelle travelled to Edinburgh in June to present this paper and receive the award.

In July, the Department farewelled fourteen Indonesian students who completed the requirements of theMaster of Health Services Management Program. The Department was presented with an Indonesianwall hanging.

Highlights of 2001

David Goddard was the recipient of the Vice-Chancellor’s Awardfor Distinguished Teaching. David was nominated by a group offifth year medical undergraduates and presented with his awardat the Faculty Graduation ceremony in December. Davidteaches undergraduate medical students with enthusiasm andpassion and everyone at DEPM congratulated David on therecognition of the effort he puts in to make learning enjoyable.

Staff in 2001

Professor & Head of DepartmentJohn McNeil, Professor MBBS, MSc, PhD, FRACP, FAFPHM

Associate ProfessorsMichael Abramson MBBS(Hons), BMedSc, PhD, FRACP, FAFPHMRachelle Buchbinder MBBS(Hons), MSC, FRACPFlavia Cicuttini MBBS(Hons), MSc, DHTM, PhD, FRACP, FAFPHMAndrew Forbes BSc(Hons), MSc, PhDHenry Krum, MBBS, PhD, FRACPMalcolm Sim, BMedSc, MBBS, MSc, GDipOccHyg, PhD, FAFOM, FFOM, FAFPHM,

Senior Lecturers/Senior Research FellowsEsther Briganti MBBS, GDipClinEpi, FRACP. Senior LecturerLisa Demos BPharm, GDipHospPharm, PhD David Elder MBChB, DGM, MRCGP,GradDipOccHlth, MPH, FAFOM.David Fish MBBS, FAFOM, FAFPHMDavid Goddard BMedSc, MBBS, DOH, FAFOM, MFOMMargaret Hellard MBBS, FRACP.Bruce Hocking MBBS, FRACGP, FAFOMJoe Ibrahim MBBS, FRACP, MHA, PhD.Karin Leder MBBS(Hons), FRACP, MPHSandy Leggat BSc(Hons), MBA, MHS, PhDJenny Majoor MBBS, MHA, FRACMA, PhDDavid Newman MBBS, Dip Av Med, PhD.Vasuki Prahbaharan BScm GradDipStats, MASMartha Sinclair BSc(Hons), PhDVijaya Sundararajan Dr BA, MD, MPHDavid Taylor Dr MD, DRCOG, MPH, FACEMTheo Vos MD, MSc.Mark Wahlqvist BMedSci, MD, BS(Adelaide), MD(Uppsala), FAIFST, FACN, FAPHM

Lecturers / Research FellowsEmma Ashton BAppSc, PhDGeza Benke BSc MAppSci GDipQuanMeth, FAIOHLisa Collins BAppSc, PhDDeborah Glass BA(Hons), CertEd, MSc, PhDJill Ikin BA(Psych) GradDipBHlthHaida Luke BPsych, MEd(Psych), PhDDean McKenzie Mr, BA, MScDianna Magliano BAppSc(Hons), PhDKath Ogden MBBS, FRACGPGayle Savige DipTeach, BSc, GDipDiet, PhDSamantha Rizak BA, BSc, MScRosalie Woods BSc, GDipDietetics, MPH, PhD

Research AssistantsLeonie Hughes BSc(Chem)Hons, BSc(Biotech), MScPam Lightbody BScJulianna O’Keeffe BSc, GDipEdSonya Ristevski BSc(Hons)Marina Skiba BEd

Research NursesJane Brack BappSc(Nursing)Christine Dos Santos BHlthScRobyn Funston RNJudy Hankin BA(Psych)RNLinton Harris RN, DipAppSc(Nursing)Tegan James BA(Hons), RNFiona Savio BSc(Nursing), GradDipClinEpiJudy Snaddon BA, SRN, SRMJessika Willis BSc, GDipHumServRes, RPN

Computer Systems OfficerColin Fee

Administrative StaffNatalie AnderieszCarolyn BarrieRhonda Blaich BEdJohn ChelliahSandra CherryMarilyn Cowie RNMandy Hipwell BAEmma KaneSonya McKeown BA(Hons)Doris Toh Bcomm, MIntBusAdminMaida O’KeefePhyllis ToparlanisSevim Zongur

Postgraduate scholarsZahid Ansari MBBS, FAFPHM, MSc, MPHChristopher Barton BSc, MMedScStephen Begg BA(Hons), MPHRebecca Braham BSc(Hons)Jim Black, MBBS(Hons) DTM&H, MCommHRochelle Eime BappSc(Hons)Mike Glisson MAppSci, DAppSci (Med Rad), DqualSteven Haas Bpharm, BpharmSc(Hons)Andrew Haydon MBBS, FRACPHelen Kelsall MB BS, MPH, MhealthSc, FAFPHMAnthony Kwok GdipPhysio, GDipHlthAdmin, MHADanny Liew BMedSc, MBBS, FRACPStephen Lim BSc(Hons)Bebe Loff MA(Lond), BA, LLBCaroline Marshall MBBS, GDipClinEpi, FRACPMelanie Matheson MAppSc, BSc.Alastair Meyer BSc(Hons), BMedSc, MBBS, FACEMMark Nelson MBBS, GDipFamMed, MFamMedAlex Padiglione MBBS, FRACPAnne-Marie Pellizzer MBBS, FRACPLouise Prentice MBBS, FRACPBrent Robertson MBBSKaren Smith BSc(Hons), GDipEpi&BiostatHugo Stephenson BSc, MBBSRhonda Stuart MBBS FRACPRwth Stuckey BappSc, GradDipErgonomics, MPHAnita Wluka MBBS, Dip Int Med, FRACPBoheng Zhang MBBS, MMed

Staff in 2001 continued

Research nurses from leftJane Brack, Robyn Funston, Judy Snaddon andChristine Dos Santos

From leftSevim Zongur, Pam Lightbody, Sam RizakChristine Dos Santos, Phyllis Toparlanisand (front) Jane

Research in the Department covers a wide range of specialist areas, and the Department isorganised into individual research units with their own specialist staff.

• Aviation Medicine Unit

• Biostatistics Unit

• Diagnostics Unit

• Clinical Epidemiology Unit

• Clinical Measurement Unit. (In collaboration with Cabrini Hospital)

• Clinical Pharmacology Unit

• CRC for Water Quality and Treatment

• Epidemiological Modelling Unit.

• Health Services Management & Research Unit

• Infectious Disease Epidemiology Unit

• International Health & Development Unit. (In collaboration with the Asia

• Pacific Health & Nutrition Centre, Monash)

• Occupational & Environmental Health Unit

• Preventive Medicine Unit

• Trauma and Sports Injury Epidemiology Unit

These units often work in collaboration,bringing several specialist skills to research projects asthey are needed. Research in the Department covers areas such as -

Applied clinical research Cardiovascular disease

Clinical epidemiology Clinical preventive medicine

Diagnostics Drug evaluation

Drug safety monitoring Environmental toxicology

Epidemiological modelling Evidence based medicine

Health management Health promotion

Health services research Infectious disease epidemiology

Information technology Nutrition

Occupational health Outbreak investigation

Pharmaco-epidemiology Pharmaco-economics

Water quality

Research at DEPM

The Biostatistics Unit plays a critical role in the research endeavours ofthe Department. Staff of the Unit hold chief investigator and/or associateinvestigator status on many of the Department's research projects andmake substantial contributions to the design, data collection, and analysisof these projects. The Unit also contributes to many epidemiologicalprojects of external research groups and institutes. Staff pursue ongoingmethodological research, in particular on the analysis of ordinal outcomes,analysis of longitudinal studies, the use of hierarchical regression modelsapplied to institutional ranking, and in statistical computing.

The unit teaches applied biostatistics to medical and biomedical scienceundergraduate students, and students enrolled in the various postgraduatecourses in health and clinical research in the Department. The Unit isalso involved, along with other national centres of biostatistics, in teachinga new Masters in Biostatistics course by distance education.

Biostatistical Consulting Services

Over recent years, there has been a major increase in demand forbiostatistical support from many sectors of the health system. This is inpart due to the increasing complexity of study design, increasingawareness of the need for modern statistical analysis methods, and themore rigorous demands of peer-reviewed journals and granting bodies interms of the use of statistics.

This service aims to facilitate access to appropriate and modern statisticalmethods in health research; offer specialist services in the areas ofepidemiological, clinical and biomedical data analysis and provide trainingin the application of statistical methods for health researchers.

For enquiries email [email protected] or go towww.med.monash.edu.au...., phone (03) 9903 0991, fax (03) 9903 0556

Biostatistics Unit

Andrew Forbes heads theBiostatistics Unit whichconsists of 5 biostatisticians.He received a BSc (Hons) inStatistics from MonashUniversity in 1984, and a PhDin Statistics in 1990 fromCornell University, USA. Heworked at Ciba-GeigyPharmaceuticals USA, as apostdoctoral fellow developingclinical trial methodology priorto joining Monash University.

Head of UnitA/Prof Andrew Forbes, BSc(Hons),MSc,PhDPhone 03 9903 30580, email [email protected]

Michael’s administrative responsibilities include a GrantReview Panel of the NH&MRC. He has previously heldpositions in the Thoracic Society of Australia & NewZealand, Asthma Foundation of Victoria and the NationalAsthma Campaign. He is a member of the ScientificCommittee for the International Society for EnvironmentalEpidemiology conference to be held in Perth in 2003.

Current research in this Unit covers the epidemiology ofasthma and chronic obstructive lung disease, includinggenetic and environmental risk factors, asthma mortality,patient education and adherence to asthma managementplans. This work has been supported by the NationalHealth & Medical Research Council, Department ofHuman Services, Victorian Health Promotion Foundation,Australian Lung Foundation and the Asthma Foundationof Victoria.

The Unit is actively involved in the Cochrane Collaboration- an international effort to review and disseminate evidenceof effective treatments. Members have contributed anumber of systematic reviews to the Cochrane Library.

Members of the Unit currently teach Epidemiology andEvidence Based Medicine to medical students andcoordinate the Graduate Diploma and Master of ClinicalEpidemiology and Doctor of Public Health at MonashUniversity.

Head of UnitA/Prof Michael Abramson MBBS(Hons), BMedSc, PhD, FRACP,FAFPHM.

Clinical Epidemiology Unit

Michael Abramson is alsoDeputy Head of the Departmentand a visiting specialistphysician in respiratorymedicine at the Alfred Hospitalin Melbourne. He graduated inMedicine from Monash in 1979and received his PhD from theUniversity of Newcastle in 1990for research into occupationalasthma.

Clinical Measurement Unit In collaboration with Cabrini Hospital

Current research programs at the Department of Clinical Epidemiology atCabrini Hospital cover a wide range of initiatives primarily concerningmusculoskeletal disorders.

The Australian Rheumatoid Arthritis Database, which aims to collectlongitudinal data on outcomes in rheumatoid arthritis in Australia, hascommenced pilot studies. The database will be housed at Cabrini Hospitaland co-members on the research committee include A/Prof Lyn March andDr. Marissa Lassere. An NHMRC funded clinical trial is investigating the valueof physiotherapy post-hydrodilatation for frozen shoulder. Other trials ofinnovative new therapies for soft tissue disorders of the shoulder, elbow, knee,heel are also underway and/or nearing completion.

Other projects include estimating risk of malignancy in rheumatic diseases,magnetic resonance imaging in rheumatoid arthritis, quality of life, patienteducation, complementary medicine and outcome measurement. Her workhas been supported by various local, national and international bodies.

Rachelle currently coordinates and teaches the postgraduate courses inClinical Epidemiology and Measurement. She also supervises BMedSci, MPHand PhD students.

Head of UnitA/Prof Rachelle Buchbinder MBBS(Hons), MSC, FRACPPhone 03 9509 1652, email [email protected]

Rachelle Buchbinder is a practicing

rheumatologist and clinical

epidemiologist. She is the Director

of the Department of Clinical

Epidemiology at Cabrini Hospital.

Rachelle graduated in Medicine

from Monash University in 1981 and

received a Masters of Science in

Clinical Epidemiology from the

University of Toronto in 1993.

Staff in 2001

Dr Jan Lucas Hoving PostDoctoral Research FellowCorry Garamszegi (Cabrini)Research Assistant/RNLyn Oldham (Cabrini)Administrative Officer

The research activities of the Clinical Pharmacology Unit are focusedprimarily around new drug development for cardiovascular diseasestates. Drugs currently undergoing clinical research include endothelinreceptor antagonists, cytokine antagonists and drugs that augmentendogenous vasodilator systems. The main areas of research interestare those of autonomic dysfunction and endothelial dysfunction incardiovascular disease. Clinical techniques employed include heartrate variability monitoring, titriated noradrenaline measurement ofsympathetic activity, noninvasive assessment of baroreflex sensitivityand invasive and noninvasive forearm blood flow studies using venousinclusion plethysmography.

The Unit also conducts basic research in the Department of Medicine’slaboratories at the Monash Medical School. This involves animalmodels of heart failure with assessment of intracardiachaemodynamics, neurohormonal status and gene expression ofimportant regulatory factors, particularly cytokines and growth factors.A number of novel and existing drugs are currently being studied inthis manner.

The Unit is also interested in cell culture of rat fibroblasts and humanmononuclear cells as markers for activity of certain growth factors inman.

.

Head of UnitA/Prof Henry Krum MBBS, PhD, FRACPPhone 03 9903 0042, email [email protected]

Clinical Pharmacology Unit

Henry Krum completed his MBBS at

the University of Melbourne in 1981,

became a Fellow of the Royal

Australasian College of Physicians

in 1989 and completed a PhD at the

University of Melbourne in 1991. As

well as head of this unit, Henry is

Head of Clinical Pharmacology at the

Alfred Hospital, Adjunct Assistant

Professor of Medicine, Division of

Circulatory Physiology at Columbia

University College of Physicians and

Surgeons, and consultant physician

at the Alfred Heart Failure Centre, the

Alfred Baker Medical Unit and the

Alfred Healthcare Group.

Staff in 2001

Research in 2001

Carvedilol Open Label Assessment (COLA)Effect of rapid lipid lowering with atorvastatin on autonomic parameters innormal subjects andhyperlipidaemic patients with coronary artery diseaseElite II StudyEndothelin antagonist Bosentan for lowering cardiac events in heart failure(ENABLE-1)Research into Etancercept: CytOkine antagonism in VEntriculardysfunction trial (RECOVER)Valsartan Study

Pauline Branley MBBS, FRACP, PhDRachel Denver (Dept of Medicine)Adam Bystrzycki (Dept of Medicine)Linton Harriss RN, DipAppSc(Nursing)Paul Martin (Dept of Medicine)Tegan James BA(Psych), BA(Lit)Anne-Marie Pellizzer MBBS, FRACPFiona See (Dept of Medicine)Marina Skiba BEd(Sec)SciRichard SkibaAlex Tzanidis (Dept of Medicine)Julie WilliamsEmma Windebanke (Dept of Medicine)Sue Xiang (Dept of Medicine)Jun Yao (Dept of MedicineSevim Zongur

Contributions to teaching include coordination and teaching ResearchMethods in the Master of Public Health, coordination of Epidemiologyand Biostatistics by distance mode of delivery, and Medicine andResearch for 4th year undergraduate medical students.

Current research in this Unit includes using magnetic resonance imagingto understand factors that affect joint cartilage in healthy and diseasedstates and economic evaluation of medical diagnostics.

Diagnostics Unit

Head of Unit- A/Prof Flavia Cicuttini MBBS(Hons), PhD, MSc, DLSHTM,FRACP, FAFPHMPhone 03 9903 0053, email [email protected]

Flavia graduated in medicinefrom Monash University in1982 and completed a PhDat the University of Melbournein 1993. She then completedan MSc at the University ofLondon, looking at risk factorsfor osteoarthritis andcompleted further study at theLondon School of Hygieneand Tropical Medicine in1996. Flavia is a member ofthe NHMRC ResearchFellowships Advisory Panel,Royal Australasian College ofPhysicians ResearchAdvisory Committee andJacquot SelectionCommittee, RACP, andOARSI study group onosteoarthritis of the hand.

Research in 2001

Clinical trial of antioxidants to slow progression of osteoarthritis. Rate of knee joint cartilage loss in people with osteoarthritis compared tonormal controls. Does oestrogen replacement therapy (ORT) prevent osteoarthritis? A cross-sectional study of the role of gender, pubertal stage, linear growthand physical activity in knee cartilage development in children. Are professional runners at increased risk of losing knee joint cartilage, thuspredisposing them to osteoarthritis? Human rights and healthcare

Staff in 2001

Bebe Loff MA (Lond) BA LLB Mike Glisson MAPPSC, DAPPSC(Med Rad) Louise Prentice MBBS, FRACP Anita Wluka MBBS, Dip Int Med, FRACP Fiona Savio BSc, GradDipClinEpi

Theo Vos qualified as a medicaldoctor in the Netherlands in 1980.He worked for 9 years in districthospitals and provincial healthoffices in Lesotho and Zimbabweperforming a combination ofclinical and public health duties.After completing a MSc degreein Public Health in DevelopingCountries at the London Schoolof Hygiene and Tropical Medicinein 1994, he stayed on as alecturer. His research interestsincluded the use of burden ofdisease and cost-effectivenessanalyses in priority setting and thedevelopment of methods toevaluate the quality of maternityand child health services in low-income countries. In 1997, hejoined the Department of HumanServices (DHS) in Victoria. Hehas completed a burden ofdisease study for Victoriaadapting the methods developedfor the Global Burden of Diseasestudy to the Australian context inclose collaboration with ColinMathers at the Australia Instituteof Health and Welfare.

In collaboration with the Department of Human Services.

Head of Unit - Dr Theo Vos MD, MSc

Phone 03 9903 0049, email [email protected]

Currently, he is undertaking cost-effectiveness analyses in the areasof cancer, cardiovascular disease and mental disorders, buildingon the models developed for the burden of disease study inpartnerships between DHS, academic institutions and health NGOs.This unit aims to develop epidemiological and economic models toinform decisions on resource allocation in health. Research effortsinitially focussed on cost-effectiveness analyses of various preventiveinterventions for coronary heart disease (CHD). In collaboration withthe Centre for Health Program Evaluation and the Monash Instituteof Public Health, the unit is now undertaking the Assessing CostEffectiveness (ACE) Heart Disease Project which is funded by theNHMRC.

Epidemiological Modelling Unit

Staff in 2001

Dr Emma Ashton BAppSc, PhD, Research FellowMs Jane Brack BAppSc(Nursing), Research NurseMr Stephen Begg BA(Hons), MPH, PhD StudentMs Christine dos Santos BHlthSc, Research NurseMs Robyn Funston RN, Research NurseDr Andrew Haydon MBBS, FRACP, PhD StudentDr Danny Liew MBBS(Hons), BMedSc, PhD StudentMr Stephen Lim BSc(Hons) BA, PhD StudentDr Dianna Magliano BAppSc(Hons), PhD, Research FellowMs Judy Snaddon BA, SRN, SRM, Research NurseDr Vijaya Sundararajan BA, MD, MPH, Senior Lecturer

Research in 2001

Improving the cost-effectiveness of health services for the prevention andtreatment of coronary heart disease.The CHD Prevention Model - Cost-effectiveness of interventions forcardiovascular disease in Australia.Cost of Myocardial Infarction and heart failure in the Community (CosMIC)Epidemiology of hypertension in AustraliaRisk and determinants of fatal and non-fatal coronary heart disease in theMelbourne Collaborative Cohort StudyThe Victorian Healthy Retirees Cohort StudyImproving cost effectiveness of health services for the prevention andtreatment of coronary heart disease.Take Heart

Health ServicesManagement Unit

Jenny Majoor is a medical graduate with specialistqualifications in Medical Administration and Public Health, aPhD in Health Services Research, a Master of HealthAdministration and a Graduate Certificate in Higher Education.Jenny is also an adjunct Assistant Professor in Health ServicesManagement and Policy at George Washington University,USA. She is a leading educator in the field of Health ServicesManagement and was awarded the Faculty of Medicine SilverJubilee Teaching Prize for 1999.

Head of Unit - Dr Jennifer Majoor MBBS, MHA,FRACMA, PhD

The Unit is involved with a number of research projects thatfocus on the interface between health management andeffective and efficient health service organisation and themeasurement and improvement of quality in health care.

Health Services ResearchUnit

Head of Unit - Dr Joseph Ibrahim MBBS, FRACP,MHA, PhD

The work of the Health Services Research Unit has beenunderway since 1995 with a major focus on measuring andimproving quality in health care. Performance measurementand quality improvement research provides a mechanism toallow accountability for fund providers and provides a visiblemeans of protecting patients from inappropriate or sub-optimalcare. In 2000, Joe Ibrahim was invited to Lebanon by a majorproject funded by the World Bank to provide advice on qualityof care and health services reform in acute general hospitals.Joe visited a range of hospitals in Lebanon and also the Advisorto the Minister of Health and the Lebanese Army Commanderof Health Services.

Joe Ibrahim completed a Doctorate of Philosophy (PhD) in thefield of quality of care evaluation and performance indicators.His principal area of expertise is in the assessment of thequality of clinical care and the development of quality indicatorsand he has made major contributions to Federal and StateHealth Department projects in this area, including thedevelopment of performance measures for effective dischargeand evaluation of clinical risk management models in Victoria.Dr Ibrahim has also worked internationally on a World BankProject developing a system for hospital accreditation inLebanon and co-ordinated a course on Health Care Quality inIndonesia.

In 2002

Jenny Majoor and Joe Ibrahim left the Department and these units were integrated into one unit, The Unit of Health ServicesManagement and Research, headed by Prof Just Stoelwinder.Phone: +61 3 9903 0559Fax: +61 3 9903 0044Email: [email protected]

Infectious Disease Epidemiology includes the study of the prevalence of infectionsin populations, the identification of risk factors, and the development andevaluation of effective treatment measures and prevention strategies.

Through its partnership with the CRC for Water Quality and Treatment, the Unitis a leading centre for research on public health issues relating to drinking waterquality. Dr Leder is Leader of the Epidemiology Program of the Health andAesthetics Program Group of the CRC. Other research interests of the unitinclude infectious disease problems in clinical medicine, vaccination, refugeehealth and traveler’s health.

Infectious Disease Epidemiology Unit

Head of Unit - Dr Karin Leder, MBBS, FRACP, MPH, DTM&H

Karin Leder is an infectious diseasephysician. After completing hermedical and specialty training, sheundertook an Infectious DiseaseFellowship at the Beth IsraelDeaconess Medical Center inBoston. During her stay in the USA,she completed a Masters of PublicHealth at Harvard University andalso became certified in TropicalMedicine. On her return to Australiain 2001, she was appointed to theposition of Senior Lecturer and Headof the Infectious DiseaseEpidemiology Unit at DEPM. Theprevious Head of the Unit, AssociateProfessor Christopher Fairley,resigned earlier in the year to takeup the position of Professor in theDepartment of Public Health at theUniversity of Melbourne.

CRC for Water Quality & TreatmentCooperative Research Centre for Water Quality and TreatmentProgram Group Leader - Prof John McNeil, MBBS, MSc, PhD, FRACP, FAFPHMProgram Leader - Dr Karin Leder, MBBS, FRACP, MPH, DTM&H

In recognition of the fundamental importance of safe drinking water to communityhealth, the CRC for Water Quality and Treatment has incorporated an active publichealth research program since its formation in 1995. This program has beencoordinated and carried out by DEPM in collaboration with other CRC participants.

This year saw the success of the CRC’s application for an extension ofCommonwealth and industry funding to 2008, and growth of its membership toinclude 28 participating organisations across Australia. The research program ofthe Centre has been restructured and expanded, with DEPM retaining thecoordinating role for the public health component; now renamed Health andAesthetics.

Major projects completed during the year included case-control studies of sporadicCryptosporidiosis in Melbourne and Adelaide, and development of a computerisedsurveillance system using neural networks to evaluate data and predict futuretrends in gastroenteritis rates. Work also continued on development of a formalrisk management framework for water supplies in collaboration with the NHRMC,and integration of the framework into the Australian Drinking Water Guidelines.Production of the newsletter Health Stream also continued, with readership nowextending to over 50 countries.

Staff in 2001Dr Martha Sinclair BSc(Hons) PhD, Senior Research FellowDr Margaret Hellard MBBS, PhD FRACP, NHMRC Clinical Research FellowMs Samantha Rizak BA BASc MSc, Research FellowMs Pam Lightbody BSc, Research AssistantDr Jim Black MBBS(Hons), DTM&H, NMCommH, PhD StudentDr Caroline Marshall MBBS FRACP, PhD StudentDr Teresa Mitakakis BSc(Hons) PhD, Research FellowDr Alex Padiglione MBBS, FRACP, PhD Student

Head of Unit - A/Prof Malcolm Sim BMedSc, MBBS, MSc, GDipOccHyg, PhD, FAFOM, FFOM, FAFPHMPhone 03 9903 0582, email [email protected]

This unit has a very active research and teaching program, primarilyconcerned with the prevention of human disease from hazards inthe workplace and the environment. The Australian Gulf WarVeterans’ Health study, undertaken in collaboration with HealthServices Australia began in 2000. This is a large multicentre study,in which all 1872 Australian Gulf War Veterans are being invited toparticipate, along with a similar size comparison group of defenceforce personnel who did not serve in the Gulf War. Data collectionfor this study will continue throughout 2001, with results availablemid 2002. Another major new study last year was the occupationalexposure part of the NHMRC funded study on the causes of COADin older people. Collection of occupational data will continue through2001.

Occupational & Environmental Health Unit

Malcolm Sim’s research interestsare in human health effects fromoccupational and environmentalchemical exposures, occupationaldisease surveillance and riskassessment. He is a Fellow of theAustralasian Faculties of PublicHealth Medicine and OccupationalMedicine, RCP, and the UK Facultyof Occupational Medicine, RCP.Malcolm is Censor-In-Chief of theAustralasian Faculty of OccupationalMedicine and on the Editorial Boardfor the journal “Occupational andEnvironmental Medicine”. He is aproject leader in the CRC for WaterQuality and Treatment with a specialinterest in arsenic in drinking water,and is Principal Investigator for theAustralian Gulf War Veterans HealthStudy. He is also on the ScientificCommittee for Epidemiology inOccupational Health of theInternational Commission onOccupational Health. Malcolm wasalso successful in a proposal to holdthe 2004 International Symposium onOccupational Epidemiology inMelbourne.

Staff in 2001Dr. David Elder MBChB, DGM, MRCGP,GDOH, FAFOMDr. David Fish MBBS, FAFOM, FAFPHMDr. David Goddard BMedSc, MBBS, DOH, FAFOM, MFOMDr. Bruce Hocking MBBS, FRACGP, FAFOMDr Tony La Montagne ScD, MA, MEdDr Helen Kelsall MBBS, MPH, MHSc, FAFPHMDr Geza Benke BSc, MAppSci, DipQuanMeth, PhDDr Deborah Glass MSc, DipOccHyg, PhDJill Ikin BA(Psych), GradDipBHlthPeter Ittak BEcJean Meaklim BSc(Hons), MAppS, PhD studentJudy Hankin BA(Psych),RNJulianna O'Keeffe BSc, DipEd, GradCertOccHygEwan MacfarlaneEmma Kane BALucy Macfarlane

Research in 2001

Australian Gulf War Veterans Study - A health study of Australia’sPersian Gulf War veteransArvasc - Arsenic absorption and vascular disease.Arsenic absorption in BangladeshBenzene studyCauses of chronic obstructive lung diseases in older peopleHealthwise - A study program comprising several studies of health andwork in employees of Alcoa of Australia Ltd, Portland Aluminium andKAAL Australia.SABRE - Surveillance of Australian workplace based respiratoryevents.

This Unit provides the Department with expertise in clinicalaspects of preventive medicine and health promotion. The Unitmanages an active program of clinical trials and works in closeconjunction with the Epidemiological Modelling Unit. During2000, the Department continued analysis of data from theMAVET study, finalised the VECAT trial and continued theASFAST trial. A major report of epidemiological and preventionaspects of renal diseases was completed for the AustralianKidney Foundation and the Unit continues to undertakecollaborative work on clinical decision support applied tocardiovascular prevention.

Preventive Medicine Unit

Head of Unit - Prof John McNeil MBBS, MSc, PhD, FRACP, FAFPHMPhone 03 9903 0565, email [email protected]

John McNeil graduated in medicinefrom the University of Adelaide in1971 and undertook his medicalspecialist training at the RoyalAdelaide and Austin Hospitals. Hesubsequently completed his PhD inclinical pharmacology at theUniversity of Melbourne and an MScin Epidemiology at the University ofLondon. After spending ten yearsin Clinical Pharmacology at theAustin Hospital, he was appointedto the Head of Epidemiology &Preventive Medicine in 1986. JohnMcNeil’s principal interests includecardiovascular epidemiology, drugsafety and toxicology.

Staff in 2001Dr Pauline Branley MBBS FRACRDr Esther Briganti MBBS(hons), FRACP, Grad Dip ClinDr Anna Peeters PHDDr Dianne Magliano BAppSc(Hons), PhDMs Sonya Ristevski BSc (Hons)Dr Andrew Haydon MBBS, FRACPDr Danny Liew MBBS, BMedScMr Stephen Lim BSc(Hons)Dr Mark Nelson MBBS, GDipFamMed, MFamMedMs Karen Smith BSc(Hons), Grad Dip Epi & BiostatsDr Hugo Stephenson MBBS, BSc

Caroline is widelyregarded both internationally and nationally asAustralia's leading sports injury epidemiologist. Inaddition to her sports injury prevention expertise,she has a background in non-communicablediseases epidemiology, biostatistics, clinical trialsand broader injury prevention. She holds a PhD inBiostatistics/Epidemiology from Monash in 1995and an MSc in Biostatistics from La TrobeUniversity in 1986. She is the Head of the VictorianState Trauma Registry which is based in theDepartment. This exciting initiative will beestablishing a state-of-the-art trauma registry andoutcomes monitoring system for Victoria.

She also leads an active sports medicine researchteam. Her research interests include trauma andinjury surveillance systems, monitoring andpredicting trauma outcomes, the epidemiology oftrauma, sports injury epidemiology and theevaluation of the effectiveness of sports injuryprevention measures. She is a sports safety andpublic health adviser to the CommonwealthDepartment of Health and Aged Care, the AustralianSports Commission, Sports Medicine Australia,Sport and Recreation Victoria, the Victorian HealthPromotion Foundation and the Australian RugbyUnion. She chairs the National SportSafeCommittee and is a member of the editorial boardfor the British Journal of Sports Medicine. FromJanuary 2002, she will be the Editor-in-Chief of theJournal of Science and Medicine in Sport..

Trauma & Sports Injury Epidemiology

Head of Unit - A/Prof Caroline Finch BSc(Hons), MSc, PhD, ASTAT

Telephone: +613 9903 0581Fax +613 9903 0576Email: [email protected]

Research - Sports injury prevention

AFIPP - Australian Football Injury Prevention ProjectSQERP - Squash Eyewear Research ProjectChronic brain injury in boxers A review of countermeasures to prevent rugby unioninjuriesDoes warm-up prevent golf injuriesRisk management plans for sports safetyPregnancy and risk of injury in sportThe Western Austarlian Sports Injury StudyAn audit of the safety practices of sporting clubs

Information about the Victorian State Trauma Registryis on page 26.

Staff in 2001

Dr Lisa Collins BAppSc, PhDMs Rebecca Braham BSc(Hons) PhD CandidateMs Rochelle Eime BAppSc(Hons) PhD CandidateMs Chris Faulkner RN, BNurs, GradCertHlthInfMs Belinda GabbeMs Rachel JoyceMs Sue McLellan RN, (RMH)Ms Sonya Ristevski BSc(Hons)Mr Steven WhiteMs Jessika Willis BSc, GDipHumServRes, RPNMs Tsharni Zazryn

Other collaboratorsProf John McNeilProf Peter CameronMs Karen Smith

The Victorian Trauma Registry is based in this unit, a

collaboration between Monash University, the

University of Melbourne, the Royal Melbourne Hospital,

the Alfred Hospital and the Victorian Department of

Human Services.

The unit also carries out research in sports injury

prevention.

Research projects 2001

A randomised trial of telephone support for chronic heart failure patients at high risk ofrehospitalisation.Prof A Tonkin, A/Prof H Krum, Prof L Piterman. National Heart Foundation, 2000-2001Patients with heart failure have poor quality of life and are frequently hospitalised and rehospitalised because of their chronic

heart failure. This project seeks to implement a national trial of telephone support by trained nurses to enable patients and

their families to maintain their health in a stable a manner as possible in their homes. It is particularly important to develop

support for people who live in rural and remote areas and for patients who speak a language other than English and this will

be accomplished in this project for the trial population. Positive outcomes from the project in terms of reduced rehospitalisation,

and improved quality of life for participants will enable the telephone support program to be implemented on a natonal basis

for people with severe heart failure.

Unit of Clinical Pharmacology

A system for the early detection of outbreaks of water-related gastroenteritis in AustraliaCRC for Water Quality and Treatment. Dept of Human Services 1998-2001This project extends work carried out in an earlier feasibility study by developing a system using existing data sources and

artifical neural networks to enhance the sensitivity and speed of surveillance for waterborne outbreaks of gastroenteritis.

CRC for Water Quality & Treatment

Australian football injury prevention project: The effectiveness of headgear and mouthguardsfor preventing football injuries.C FinchVicHealth 2000-2002Unit of Trauma and Sports Injury Epidemiology

Case-control study of risk factors for sporadic Cryptosporidiosis in the general population.

Dr Brent Robertson.CRC for Water Quality and Treatment. Water Services Assocation of Australia, Melbourne Water, SouthEast Water, City West Water, Yarra Valley Water. 1997-2001This study assessed the importance of risk factors for cryptosporidiosis in the general community. The preliminary stage of

the project involved the testing and validation of a water consumption questionnaire.


Case-control study of Cryptosporidiosis - Adelaide and Melbourne.CRC for Water Quality and Treatment. Water Services Assocation of Australia, Melbourne Water, SouthEast Water, City West Water, Yarra Valley Water. 1997-2001Cryptosporidium parvum has been recognised as a significant cause of gastroenteritis. Some outbreaks of infection have

been associated with contaminated water supplies, but little is known about risk factors for sporadic cases which probably

number more in total than recognised outbreaks. These projects are assessing the importance of risk factors for

cryptosporidiosis in Melbourne and Adelaide by comparing cases (people with laboratory diagnosed infection) and controls

(healthy people selected at random from the general population). This project will indicate whether drinking water plays a

significant role in Cryptosporidium gastroenteritis and will guide water authorities in water treatment decisions.


Cost effectiveness of MRI in the management of occult scaphoid fracturesF Cicuttini, S Stuckey, D Taylor. Commonwealth of Australia, Consultative Committee on DiagnosticImaging Research Grant. 2001-2002Fracture of the scaphoid bone is a common injury occurring predominantly in young people. In up to 25% of cases the fracture

is not visible on the initial X-ray. Because failure to immobilize the injury in the early stages can result in complications, including

avascular necrosis and arthritis in the longer term, if the injury is suspected a cast is applied. Recently MRI has been shown

to be an accurate method of diagnosing scaphoid fractures in the early stages. In this randomised controlled trial we are

loooking at whether an MRI performed 2 to 5 days after the injury is cost-effective and improves patient outcome.

Diagnostics Unit

Cost of myocardial infarction to the community (COSMIC)Prof. John McNeil, Prof G Donnan. Bristol-Myers Squibb. 2000 - 2002This is a collaborative study between DEPM and the National Stroke Research Institute. The aim of this project is to determine the

costs and quality of life associated with myocardial infarction (heart attack) and heart failure to the Australian community. This is a

prospective multi-center cohort study recruiting 140 first-time in a lifetime myocardial infarction patients and 180 heart failure patients

from 11 hospitals in metropolitan Melbourne. The study aims to collect not only direct costs associated by the treatment of the patient,

but also indirect costs associated with their disease, eg loss of patient income. Furthermore, this project will assess not only costs

associated with a patient's acute admission to hospital, but also the downstream (12 months) costs associated with their disease.

Research from this project feeds into the CHD Prevention model by allowing the determination of the potential cost and quality of life

savings from preventing myocardial infarction and heart failure.

Unit of Preventive Medicine

Disinfection by-product exposure assessmentCRC for Water Quality and Treatment. Natural Sciences and Engineering Research Council of Canada. 1999-2001Chlorination and chloramination remain the most widely practised methods of drinking water disinfection because of their relatively

low cost, simplicity and proven effectiveness against common microbial pathogens. However a number of concerns have been

raised about the possible health effects of disinfection by-products which are formed from natural organic matter in the water. This

project aims to develop more reliable and accurate methods to measure the exposure of individual people to disinfection by-products

in drinking water, in order to facilitate improved epidemiological studies of health effects.


Do dairy products contribute to the high asthma prevalence among young adult Australians?R Woods, M Abramson. Dairy Research & Development Corporation, 1999-2001.Asthma is a major public health problem in Australia. There is evidence that the prevalence of asthma is increasing both in children

and adults. It has been hypothesized that changes in dietary habits over the past 30 years may be responsible for some of the global

increase in asthma prevalence, severity and mortality. We have previously found that food related respiratory symptoms are

commonly reported by patients with asthma, which may lead to inappropriate dietary modification. However accurate and appropriate

dietary assessments have not yet been applied to clarify relationships between exposure to particular foods or micronutrients and

the development of asthma. No previous study has simultaneously collected detailed dietary information from ethnically diverse

young adults, both with and without asthma. We are in the unique position to be able to collect this data as part of an international

study which is designed to identify the risk factors associated with the international variation in asthma prevalence in young adults.

Unit of Clinical Epidemiology

Epidemiology of hypertension in AustraliaProf J McNeil, Dr D Liew, Dr A Haydon, Dr D Magliano. Bristol-Myers Squibb 2001This study is currently underway into the epidemiology of hypertension in Australia. Using cross-sectional data, the distribution and

types of hypertension and associated treatment will be examined. Associations between treatment coverage and other variables

may elucidate risk factors for inadequate management of hypertension. Lifestyle and dietary factors and their associations with

blood pressure will also be explored. These data will subsequently be used to model the long term effects of hypertension in

Australia, such as stroke, cardiac and renal disease, and how these may be minimised via appropriate interventional strategies.

Unit of Preventive Medicine & Epidemiological Modelling Unit

Research projects 2001 continued

Evaluating EtO exposures under OSHAs 1984 EtO Standard.Dr T La Montagne. US Centre for Disease Control and the National Institute for Occupational Safety andHealth. 2000-2002 (Administered through Harvard School of Public Health).This project is a historical evaluation of worker exposures under OSHA’s 1984 ethylene oxide (EtO) standard. The specific

aims are to (1) characterize EtO exposures, (2) identify potential determinants of EtO overexposure, and (3) assess compliance

with the EtO standard.

Unit of Occupational & Environmental Health

Evaluating OSH Programs in manufacturing and small business.Dr T La Montagne. US National Institute for Occupational Safety and Health, 2000-2002.(Administered through Dana-Farber Cancer Institute) .This US-based project investigates occupational safety and health programs or management systems in manufacturing

worksites. OSH programs are characterized at the organizational level using quantitative and qualitative assessment methods.

Cross-sectionally, OSH program measures will be compared to individual employee reports of OSH conditions as well as to

environmental level assessments of hazardous substance exposures. These analyses will contribute needed insights into

the relevance of OSH program measures for occupational health and disease outcomes (versus occupational

safety and injury, for which there is considerably more knowledge). Finally, this study complements two randomized, controlled

intervention trials. Accordingly, the impacts of multi-level (individual, organizational, and physical environmental) interventions

on OSH program measures will be assessed. This project promises to contribute significantly to the evidence basis of an

emerging international emphasis on OSH programs or management systems for addressing hazardous working conditions.


Factors influencing knee cartilage volume in healthy malesF CicuttiniArthritis Foundation of Australia. 2001Australian studies have shown a high prevalence of arthritis-related disability among the elderly, with 45% of those over 65

living independently in the community reporting that they were disabled by arthritis. A NHMRC funded study is currently

underway at the Royal Melbourne Hospital examining risk factors for osteoporosis in males. Ninety healthy males have been

recruited and a large database is available with many factors that may affect knee cartilage volume. This study will explore

the effect of homronal and lifestyle factors on knee cartilage volume through MRI examinations.

Diagnostics Unit

Health study of Australia’s Gulf War veterans.M Sim, J McNeil, L Fritschi, H Kelsall, A Forbes. Commonwealth Dept of Veterans Affairs, 2000-2001This study is being conducted in collaboration with Health Services Australia and the Commonwealth Departments of Veterans

Affairs and Defence. The study is designed to investigate whether Australian service personnel who served in the Gulf War,

have a higher than expected prevalence of medical conditions, psychological problems, respiratory conditions, immunological

abnormalities or symptom clusters, and, if so, whether these adverse health outcomes are associated with exposures and/

or stressors experienced in the Gulf War. All 1872 Australian Gulf War Veterans are being invited to participate, along with a

similar size comparison group of defence force personnel who did not serve in the Gulf War. Data collection for this study will

continue throughout 2001, with results available mid 2002.


Healthwise: A study of health and work in employees of Alcoa of Australia Limited, PortlandAluminium and the KAAL Rolling Mill.Dr M Sim, Dr L Fritschi, Prof AW Musk, Prof JJ McNeil.Project staff, Ewan MacFarlane, Geza BenkeAlcoa of Australia Ltd, 1994-2003.Healthwise is one of the largest and most comprehensive occupational epidemiological studies ever carried out in Australia.

Locations taking part in the study are smelters at Portland and Point Henry, the KAAL Rolling Mill at Point Henry, the Anglesea

power station, refineries at Kwinana, Pinjarra and Wagerup, the Bunbury shipping terminal and bauxite mines at Jarrahdale,

Huntly and Willowdale. Heallthwise consists of three major studies, a cross-sectional study of respiratory health, a new

starters study and a cancer incidence and mortality study. For further information, study staff can be contacted on

[email protected]



Improving the cost-effectiveness of health services for the prevention and treatment of coronaryheart disease.T Vos, J McNeil, J Anderson, J Richardson, N FormicaNHMRC (SRDC) 2001-2003This study is currently underway into the epidemiology of hypertension in Australia. Using cross-sectional data, the distribution

and types of hypertension and associated treatment will be examined. Associations between treatment coverage and other

variables may elucidate risk factors for inadequate management of hypertension. Lifestyle and dietary factors and their

associations with blood pressure will also be explored. These data will subsequently be used to model the long term effects of

hypertension in Australia, such as stroke, cardiac and renal disease, and how these may be minimised via appropriate

interventional strategies.

Epidemiological Modelling Unit

Investigation of the natural history of community acquired Hepatitis C in a cohort of participantswith an average of 25 years of being infected with Hepatitis C.Dr M Hellard. NHMRC Australian Clinical Research Fellowship 2000- 2004.This study will look at the morbidity and mortality of individuals with chronic Hepatitis C using biochemical markers, liver biopsies

and clinical data of study participants. We will seek to confirm the reduced prevalence of cirrhotic liver in individuals with

community acquired HCV compared to those who acquire infection through transfusion of contaminated blood products. The

study will examine the impact of Hepatitis C on the individual and their family, in particular examining the extent to which

perceptions of health and well beign change as a function of diagnosis and how HCV is experienced. The results of this study

will answer a number of important questions for people with Hepatitis C, for clinicians and others counselling those with HCV

and also for health service planners in their attempt to plan for the sequelae of HCV. It will provide insight into appropriate

management strategies to assist the process of diagnosis in a way that improves rather than reduces quality of life.

Unit of Infectious Disease Epidemiology

Is diet responsible for the high asthma prevalence among young adults?M Abramson, R Woods, F Thien, P Ireland, H WaltersNHMRC Postodctoral FellowshipThis study commenced in 1998 and was designed to look at the prevalence and risk factors, particularly dietary factors,

associated with respiratory health in young adults. A total of 3194 brief respiratory questionnaires were returned from 4456

adults aged between 20 and 44 years who were randomly selected from the electoral roles. Thus a response rate of 72% was

achieved. The results have shown that the prevalence of having asthma ever, doctor-diagnosed asthma and currently using

asthma medications has increased significantly since 1990. The second phase of the study, which involved participants coming

to our laboratory for some simple breathing and allergy tests and giving information on their usual diet has now been completed.

A total of 1601 completed the respiratory questionnaire, 1469 completed the food frequency questionnaire, 1141 completed skin

prick and lung function testing and 1075 completed the methacholine challenge for non-specific bronchial hypreresponsiveness.

We are now in the process of analyzing these results. It is anticipated that results from this study will become available over the

next 12 months.

Unit of Clinical Epidemiology

Role of urotensin II, a novel vasoconstrictor factor in cardiovascular disease.H Krum, R Hannan. NHMRC 2001 - 2003Urotensin II (UII) is a newly discovered peptide that may play an important role in human health and disease. It has been found

to be a potent constrictor of blood vessels and therefore may be involved in diseases such as hypertension and heart failure.

Furthermore, many other factors that constrict blood vessels have also been found to have effects on key organs, such as the

heart. Preliminary data suggests that this is true of urotensin II. This study will seek to determine the role of urotensin II in:

- the periphery, by assessing contraction of forearm vessels to low doses of UII in normal volunteer subjects and patients with

hypertension and heart failure;

- the heart, by measuring expression of UII and its receptor in normal and failing human heart tissue - the UII response to

experimental heart attack in therat and in cell culture of important heart cells;

- general circulation, by measuring plasma levels in health and disease.

The significance of this project is that if it is found that UII plays an important role in these diseases, then agents which block this

system may represent a major therapeutic advance in the management of these diseases.



Pilot Study For The Australian Rheumatoid Arthritis Database (ARAD): A Longitudinal Study OfThe Long Term Effects Of Rheumatoid Arthritis And Its Treatments In Australia.A/Prof R Buchbinder, A/Prof L March and Dr M Lassere (Sydney Collaboration).There has been increasing interest in the systematic collection of long-term outcome information on patients with chronic

diseases such as rheumatoid arthritis. Evidence-based information about long-term relevant outcomes such as efficacy, safety

or economic is essential for clinicians, consumers, policymakers, drug development companies and approval agencies. Importantly,

many of the new pharmaceutical and biologic treatments for rheumatoid arthritis have long-term or rare effects that cannot be

determined within the context of pre-clinical toxicological studies. Nor can these effects be determined from short-term randomised

controlled trials powered for efficacy rather than the detection of rare adverse effects. Post-approval and marketing surveillance

of putative drug attribution of an adverse event is problematic because of the absence of controls and the presence of

confounding factors such as disease severity. Therefore, in the present day, we do not have the means to determine the long-

term or rare effects of exposure to new drugs and other treatments on large populations with a potentially severe but not life

threatening chronic disease. The approximation of ‘real-world’ conditions requires the generation of a valid reference database;

sampled from the community, maintained longitudinally and free from the various biases that threatens internal validity and

generalizability of the results. The aim of this study is to develop a national rheumatoid arthritis database consisting of longitudinal

clinical data with the ultimate aim of providing better care and improving outcomes of rheumatoid arthritis sufferers in Australia.

Unit of Clinical Measurement

Pilot Study for the Efficacy of physiotherapy after hydrodilatation for frozen shoulder.R Buchbinder, S Green, K Bennell, A Forbes, A Harris ARACabrini Foundation Grant - 2001.Shoulder disorders are common, being third only to back and neck complaints as musculoskeletal reasons for medical consultation,

and account for 10% of all physiotherapy referrals. The stiff painful shoulder (SPS) affects up to 2-5% of the general population,

being more common in middle age and diabetes. It causes significant pain, disability and restrictions in activities of daily living,

work and leisure. Forty percent of sufferers will continue to have symptoms and restricted movement beyond 3 years and 15%

will have persistent disability. SPS imposes a considerable burden on the Australian health care system. Shoulder hydrodilatation

is a common treatment option shown by our research group to have short-term but not long-term benefits. Physiotherapy

following hydrodilatation may maintain the initial benefits seen with hydrodilatation. There are no studies to either support or

refute this hypothesis. In this study, we will determine whether physiotherapy offers a benefit over hydrodilatation alone and if

so, whether this benefit is sustained. In addition we will determine whether the additional cost of physiotherapy represent good

value for money. The results of this project can then be easily and immediately translated into clinical practice as recommendations

can be made about the usefulness of physiotherapy for this patient population.

Unit of Clinical Measurement

Public knowledge cross-sectional studyProf John McNeil, Ms Karen Smith. Funded by The Alfred Hospital, 2000-2001.This study is a cross-sectional phone survey which involves a random sample of rural and urban Victorians. Participants are

administered a questionnaire over the phone by a researcher. Survival from out-of-hospital cardiac arrest in Melbourne is as low

as 4%. One explanation for this is the lack of appropriate action by bystanders at the scene of an arrest. This study will determine

how people in metropolitan Melbourne and rural Victoria believe they would act when faced with a cardiac emergency. We wish

to determine the level of knowledge of cardiopulmonary resuscitation (CPR) within the community, the level of knowledge of heart

attack symptoms and potential inhibitions to performing CPR. Evaluation of base-line knowledge within the community is essential

if interventions are to be designed and specific groups are to be targeted.

Unit of Preventive Medicine


Randomised trial of telephone support for chronic heart failure patients at high risk ofrehospitalisation.Prof A Tonkin, A/Prof H Krum, Prof L Piterman. National Heart Foundation, 2000-2001Patients with heart failure have poor quality of life and are frequently hospitalised and rehospitalised because of their chronic

heart failure. This project seeks to implement a national trial of telephone support by trained nurses to enable patients and their

families to maintain their health in a stable a manner as possible in their homes. It is particularly important to develop support for

people who live in rural and remote areas and for patients who speak a language other than English and this will be accomplished

in this project for the trial population. Positive outcomes from the project in terms of reduced rehospitalisation, and improved

quality of life for participants will enable the telephone support program to be implemented on a natonal basis for people with

severe heart failure.


Risk factors for asthma, chronic bronchitis and emphysema in older adults.A/Prof M Abramson, A/Prof M Sim, Prof H Walters. NHMRC, 2000-2002Chronic obstructive pulmonary disease is a major public health problem in Australia. The main known cause is cigarette smoking

which peaked among Australian men shortly after the second world war. Now that the consequences of the epidemic of

smoking are passing, more attention needs to be paid to other causes of the condition. This study will focus on occupational and

domestic exposures and dietary factors in older people.

Unit of Clinical Epidemiology & Unit of Occupational & Environmental Health

Risk factors for asthma, chronic bronchitis and emphysema in middle aged and older adults.Victorian Tuberculosis & Lung Association 2001M Abramson, M SimAlthough clearly a major public health problem, there is no good population-based data on the prevalence of COPD in older

Australians. Whilst the importance of cigarette smoking is clear, the proportions of COPD and chronic asthma in Australia

which are attributable to occupational exposures are not known. Nor have those industries, jobs and exposures that carry a

particularly high risk yet been identified. This study extends one of our existing NHMRC funded studies, which commenced in

January 2000, looking at non-occupational risk factors for chronic lung disease in older adults.

Unit of Clinical Epidemiology & Unit of Occupational & Environmental Health

Role of urotensin II, a novel vasoconstrictor factor in cardiovascular disease.H Krum, R Hannan. NHMRC 2001 - 2003Urotensin II (UII) is a newly discovered peptide that may play an important role in human health and disease. It has been found to

be a potent constrictor of blood vessels and therefore may be involved in diseases such as hypertension and heart failure.

Furthermore, many other factors that constrict blood vessels have also been found to have effects on key organs, such as the

heart. Preliminary data suggests that this is true of urotensin II. This study will seek to determine the role of urotensin II in the

periphery; the heart and the general circulation, by measuring plasma levels in health and disease.

The significance of this project is that if it is found that UII plays an important role in these diseases, then agents which block this

system may represent a major therapeutic advance in the management of these diseases.


SABRE (Surveillance of Australian workplace Based Respiratory Events) - a pilot study.A/Prof M Sim, Dr David Elder, A/Prof M Abramson. Australian Lung Foundation, 1998-2000.SABRE is a surveillance scheme providing the first comprehensive data on occupational respiratory disease in Victoria and

Tasmania and has links to a similar scheme in New Zealand. We have also been involved in assisting a similar scheme to be set

up in NSW. Registers exist in several overseas countries, for example, the Surveillance of Work-related Occupational Respiratory

Disease program (SWORD) in the UK which has been reporting data since 1989. Occupational lung disease due to respiratory

toxins and inhalational injury can cause morbidity, disability and death. At present the incidence of such diseases is

unknown in Australia. The data sources which do exist, eg worker's compensation records, disease registers, hospital discharge

data and workplace records, all have serious deficiencies. Respiratory and occupational physicians regularly report to SABRE

whether or not they have seen cases of occupational respiratory disease.



Victorian State Trauma RegistryA collaboration between Monash University, the University of Melbourne, the Royal Melbourne Hospital, the Alfred Hospital and the

Victorian Department of Human Services. Funded by Department of Human Services.

Head of Registry- C Finch.

Steering Committee: Prof John McNeil (Monash University), Prof Peter Cameron (Royal Melbourne Hospital), Prof Joan Ozanne-

Smith (Monash University Accident Research Centre), A/Prof Don Campbell (Royal Melbourne Hospital), A/Prof Peter Danne

(Royal Melbourne Hospital), Mr Chris Atkin (Alfred Hospital), Dr David Taylor (Royal Melbourne Hospital), Ms Karen Smith (Monash

University).

Based on recommendations from the Ministerial Taskforce on Trauma and Emergency Services*, a new system of trauma care is

currently being implemented in Victoria. In order to ascertain the effectiveness of this system and to provide ongoing monitoring

of major trauma patients, a Statewide Trauma Registry is currently being established. This registry is coordinated by the Victorian

State Trauma Outcome Registry and Monitoring group (VSTORM) which is comprised of experts in trauma care and trauma

epidemiology. The registry is chaired by Professor John McNeil and is based in this Department. The Victorian State Registry was

established to collect standard trauma data from each hospital in Victoria to develop and maintain a trauma reporting and analysis

system. This will enable identification of major trauma patients within each health care entity and to monitor trauma patient care

within the state.

The Victorian State Trauma Registry and Monitoring Group will: Use the Victorian Major Trauma Registry and International

experience to develop new models for evaluating the Victorian State Trauma System; undertake regular monitoring of the

Victorian State Trauma System through the analysis of data in the Victorian Major Trauma Registry; undertake statistical analyses

of the effectiveness of the Victorian State Trauma System in reducing preventable death and permanent disability; evaluate and

advise upon the processes for the identification of current deficiencies and opportunities for improvement in trauma care so as

to improve treatment outcomes for severely injured patients; assist the Major Trauma Services and Regional Trauma Services to

undertake continuous improvement through the provision of hospital specific quality assurance data reports, and hospital/system

performance reports, and integrate available electronic databases to provide maximum benefit in evaluating the Victorian State

Trauma System.

Trauma and Sports Injury Prevention Research Unit


DEPM has a strong record of achievement in PhD training with many graduatesobtaining prestigious post-doctoral awards and securing senior positions inAustralia and overseas. The Department provides high quality research trainingfor graduates from a wide range of medical and non-medical backgrounds.

The progress of PhD students within the department is facilitated by a strongresearch environment with an extensive program of NHMRC funded research;access to extensive infrastructure support including assistance in biostatistics,data management, computing and support from experienced staff and a largestudent body.

Why study epidemiology?A PhD in epidemiology provides a unique way to value add to clinical knowledgeand skills. It provides advanced skills in clinical and/or public health research.

Epidemiology is the key scientific discipline underlying some of the most importantand rapidly developing areas of medicine.

These include:• Public health• Applied clinical research and clinical trials• Preventive medicine and health promotion• Health services research• Quality assurance and outcome measurement in healthcare• Health economics• Health policy development• Occupational and environmental health• Health risk assessment

We welcome enquiries from anyone considering undertaking a PhD. Graduatesconsidering enrolling for a PhD in the department should contact the PhDCoordinator, A/Prof MichaelAbramson, [email protected].

Candidature for suitable applicants can commence at any time of the year, howeverthe closing date for the main scholarships is in October each year. Furtherinformation about scholarships and candidature can be obtained by [email protected]

More information is available on our Department web page atwww.med.monash.edu.au/epidemiology/teaching/phdprog.htm

Post-graduate research at DEPM

Our current PhD students come from a wide range of backgrounds, including clinicalmedicine, medical administration, biological sciences, environmental health, occupationalhealth, physiotherapy and law. They are researching an equally wide range of topics andenjoy taking an active role in the academic life of the Department.

Some of our students in 2001 were -

PhD students

Danny LiewEpidemiological modelling of ischaemicheart disease in Australia.

Stephen LimCost effectiveness of interventions forcardiovascular disease in Australia.

Bebe LoffHealth and human rights.

Caroline MarshallDevelopment of a method for subtypingmethicillin-resistant Staphylococcusaureaus (MRSA).

Mark NelsonPredictors of success of themaintenance of normotension afterwithdrawal of antihypertensive drugs inthe Second Australian National BloodPressure Study.

Karen SmithOut of hospital cardiac arrest -investigating Melbourne’s “Chain ofsurvival”.

Steven HaasEpidemiology of chronic heartfailure

Rochelle EimeProtective eyewear use in squash -The role of regulation

Rebecca BrahamThe effectiveness of headgear andmouthguards for preventing footballinjuries.

Catherine JoyceAn integrated analysis of the healthworkforce in rural Australia.

Postgraduate education at DEPM in 2001 continued to expand as greater course selection andmore flexible delivery contribute to an increase in postgraduate students.

DEPM continues to be a partner in the Victorian Consortium for Public Health along with DeakinUniversity, La Trobe University and The University of Melbourne, and the Master of Public Healthcontinues to be a very popular course. Part 1 of the MPH is taught by the four universities, eachteaching two units from their own specialty areas. In Part 2, students study with the universityof their enrolment in a specialist field. Changes in 2001 include a 12 unit degree instead of 16,and new specialist areas of study.

The MPH degree Occupational & Environmental Health Stream meets the requirements of theAustralasian Faculty of Occupational Medicine (AFOM) of the Royal Australasian College ofPhysicians as approved coursework for progression to the Fellowship examination. Severalsubjects are also accredited for CME points for Fellows of the Royal Australian College ofGeneral Practitioners. The MPH is also designed to meet part of the training requirements fortrainees of the Australasian Faculty of Public Health Medicine.

Other postgraduate courses include -

Clinical Epidemiology• Graduate Certificate in Clinical Trials• Graduate Diploma in Clinical Epidemiology• Master of Clinical Epidemiology

Health Services Management• Graduate Certficate in Health Services Management• Graduate Diploma in Health Services Management• Master of Health Services Management

International Health• Graduate Diploma in International Health

For more information on our postgraduate courses go towww.med.monash.edu.au/epidemiology/

Postgraduate teaching

Abdulwadud OA, Abramson MA, Forbes AB, Walters EH. The relationships betweenpatients’ related variables in asthma: Implications for asthma management. Respirology2001; 6:105-112.

Abramson M, Bailey M, Couper F, Driver J, Drummer O, Forbes A, McNeil J. “Are asthmamedications and management related to deaths from asthma?” Am J Respir Crit Care Med2001;163:12-18.

Abramson MJ, Sim MR, Fritschi L, Vincent T, Benke G, Rolland JM. Respiratory disordersand allergies in tea packers. Occupational Medicine 2001; 51(4):259-265.

Beach JR, de Klerk NH, Fritschi L, Sim MR, Musk AW, Benke G, Abramson M, McNeil J.Respiratory symptoms and lung function in bauxite miners. Int Arch Occup Environ Health2001; 74:489-494.

Benke G, Sim M, Fritschi L, Aldred G, Forbes A and Kauppinen T. Comparison ofoccupational exposure using three different methods: Hygiene Panel, Job Exposure Matrix(JEM) and Self Reports.” Appl Occup & Env Hygiene 2001;16(1):84-91.

Benke G, Sim M, Fritschi L and Aldred G. A task exposure database for use in the aluminaand primary aluminium industry. Appl Occupational & Environmental Hygiene2001;16(2):149-153.

Benke G, Sim M, Abramson M. Long-term trends in occupational exposure. Annals of OccHyg 2001; 45(1):499.

Black J. Sustainable health information systems - a perspective from Mozambique. ThePractice of Health Information Systems in Commonwealth Countries - CommonwealthSecretariat, 54-63.

Brand C, Snaddon J, Bailye M, Cicuttini F. Vitamine E is ineffective for symptomatic reliefof knee osteoarthritis: a six month double blind, randomised, placebo controlled study. AmRheum Dis 2001; 60:946-949.

Branley P, McNeil J, Evans S, Stephenson D and Briganti E. Modelling future renal dialysisrequirements under various scenarios of organ availability in Australia. Nephrology2001;5(4): 243-250.

Briganti EM, Dowling J, Finlay M, Hill PA, Jones CL, Kincaid-Smith PS, Sinclair R, McNeilJJ, Atkins RC. The incidence of biopsy-proven glomerulonephritis in Australia. Nephrol DialTransplant 2001;16:1364-1367.

Buchbinder R, Hall S, Grant G, Mylvaganam A, Patrick MR. Readability and content ofsupplementary written drug information for patients used by Australian rheumatologists.MJA 2001;74(11):575-578.

Buchbinder R, Jolley D, Wyatt M. Population based intervention to change back painbeliefs and disability: three part evaluation. BMJ 2001;322:1516-1520.

Buchbinder R, Forbes A, Hall S, Dennett X, Giles G. Incidence of malignant disease inbiopsy-proven inflammatory myopathy. Annals Int Medicine, 2001;134(12):1087-1095.

Buchbinder R, Jolley D, Wyatt M. Breaking the back of back pain. Med J Aust2001;175:456-457.

Burris S, Lazzarini Z, Loff B. Are human rights good for your health? The Lancet 2001;358:1901.

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Cicuttini FM, Wluka AE, Stuckey SL. Tibial and femoral cartilage changes in kneeosteoarthritis. Ann Rheum Dis 2001; 60:977-980.

Davis S, Briganti E, Chen R, Dalais F, Bailey M and Burger H. The effects of Chinese herbson postmenopausal vasomotor symptoms of Australian women. Med J Aust 2001;174: 68-71.

Demos L, Kazda H, Cicuttini F, Sinclair M, Fairley CK. Water fluoridation, osteoporosis,fractures - recent developments. Aust Dental Journal 2001;46:(2):80-87.

Dewey H, Macdonnell R, Donnan G, McNeil J, Freeman E, Thrift A, Sharples C. Inter-raterreliability of stroke sub-type classification by neurologists and nurses within a community-based stroke incidence study. J Clin Neuroscience, 2001;8(1):14-17.

Dewey HM, Thrift AG, Mihalopoulos C, Carter R, Macdonell RAL, McNeil J, Donnan GA.Cost of stroke in Australia from a societal perspective. Results from the North EastMelbourne Stroke Incidence Study (NEMESIS). Stroke 2001;32:2409-2416.

Dimock J. Robman L, McCarty CA, Taylor HR. Cost effectiveness of digital cataractassessment. Aust NZ J of Ophthalmology, 2001:

Durham H, Loff B. Japan’s “comfort women”. The Lancet, 2001;357, 9252;302.

Forge BH, Briganti EM. Lipid lowering and coronary heart disease risk: how appropriate arethe national guidelines? MJA 2001; 175:471-475.

Fritschi L, de Klerk N, Sim M, Benke G, Musk AW. Respiratory morbidity and exposure tobauxite, alumina and caustic mist in alumina refineries. J Occup Health 2001; 43:231-237.

Garrett SKM, McNeil JJ, Silagy C, Sinclair M, Thomas AP, Robman LD, McCarty CA,Tikellis G, Taylor HR. Methodology of the VECAT Study: Vitamin E intervention in cataractand age-related maculopathy. Ophthalmic Epidemiology 2001.

Gibson PG, Coughlan J, Wilson AJ, Hensley MJ, Abramson M J, Bauman A, Walters EH.Limited (information only) patient education programs for adults with asthma. The CochraneLibrary, 2001; 1:1-18.

Glass DC, Gray CN. Estimating mean exposures from censored data: Exposure tobenzene in the Australian petroleum industry. Ann Occup Hyg 2001;45(4):275-282.

Goldenhar LM, La Montagne AD, Katz T, Heaney C, Landsbergis P. The interventionresearch process in occupational safety and health: An overview from the NORAIntervention Effectiveness Team. J Occup & Env Medicine 2001;43(7):616-622.

Hellard ME, Sinclair MI, Forbes AB, Fairley CK. Methods used to maintain a high level ofparticipant involvement in a clinical trial. J Epidemiol Community Health, 2001;55:348-351.

Hellard ME, Sinclair MI, Forbes AB, Fairley CK. A randomized, blinded, controlled trialinvestigating the gastrointestinal health effects of drinking water quality. Env HealthPerspectives, 2001;109:773-778.

Holst DP, Kaye D, Richardson M, Krum H, Prior D, Aggarwal A, Wolfe R, Bergin P.Improved outcomes from a comprehensive management system for heart failure. Euro JHeart Failure 2001; 3(5):619-625.

Ibrahim J. Phenomenon of quality and health-care: Snowball or an avalance? J Qual ClinPractice, 2001;21:40-42.

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Ioannides-Demos LL, Addicott R, Santamaria NM, Clayton L, McKenzie M, Fairley CK.Differences in length of stay for Hospital in the Home patients: comparing simple clinicalcoding with medical record review. Int Med J 2001;1:142-145.

Killalea SM, Krum H. Systematic review of the efficacy and safety of perhexiline in thetreatment for ischemic heart disease. Am J Cardiovasc Drugs 2001;3:193-204.

Katz SD, Krum H. Acetylcholine-mediated vasodilation in the forearm circulation of patientswith heart failure: Indirect evidence for the role of endothelium-derived hyperpolarizing factor.Am J Cardiol, 2001;87:1089-1092.

Kelsall H, Sim M. Skin irritation in users of brominated pools. Int J Environmental HealthResearch, 2001;11:29-40.

Krum H. New and emerging pharmacological strategies in the management of chronic heartfailure. Current Opinion in Pharmacology 2001,11:126-133.

Krum H, Denver R, Tzanidis A, Martin P. Diagnostic and therapeutic potential of theendothelin system in patients with chronic heart failure. Heart Failure Reviews: 2001:6;341-352.

Krum H. Differentiation in the Angiotensin II Receptor 1 Blocker class. Current HypertensionReports 2001; 3(1): 517-523.

Krum H, Gilbert R. Management of the heart failure patient with diabetes. Coronary ArteryDisease and Diabetes Mellitus 2001; 23(2): 129-135.

Krum H, Tonkin A, Jelinek M, Harris M, McNeil J, Hunt D, Kaye D, et al. National HeartFoundation of Australia and Cardiac Society of Australia and New Zealand Chronic HeartFailure Clinical Practice Guidelines Writing Panel. Guidelines for management of patientswith chronic heart failure in Australia. MJA 2001;74:459-466.

Krum H, Tonkin A, Currie R, Djundjek R, Johnston C. Chronic heart failure in Australiangeneral practice: The Cardiac Awareness Survey and Evaluation (CASE) Study. MJA,2001;174;439-444.

Krum H, Lim S. Pharmacoeconomics of beta-blockers: effective and cost-effective therapy inchornic heart failure. European J Heart Failure 2001; 3:399-402.

LaMontagne A. Evaluating OSHA’s ethylene oxide standard: Exposure determinants inMassachusetts hospitals. Am J Public Health, 2001;91(3):412-417.

LaMontagne A, Van Dyke M, Martyny J and Ruttenber A. Cleanup worker exposures tohazardous chemicals at a former nuclear weapons plant: Piloting of an exposuresurveillance system. Applied Occupational & Environmental Hygiene2001;16(2): 284-290.

Liang T, Shiel L, Teede H, Kotsopoulos D, McNeil J, Cameron J, et al. Effects of bloodpressure, smoking and their interaction on carotid artery structure and function.Hypertension 2001;37: 6-11.

Liew D, Krum H. Management of chronic heart failure in the elderly patient. ClinicalGeriatrics 2001; 9:2434.

Lim S, Vos T, Peeters A, Liew D, McNeil J. Cost-effectiveness of prescribing statinsaccording to Pharmaceutical Benefits Scheme criteria. MJA, 2001; 175:459-464.

Loff B, Hofman K, Muthuswamy V. The global forum for bioethics in research: Report of ameeting. Issues in medical ethics; 2001:IX(2):63-64.

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Loff B, Majoor JW. Healthcare rationing, patient rights and the law. MJA. 2001;174:472-473.

Loff B, Burris S. Compulsory detention: limits of law. The Lancet 2001;368:146.

Loff B. Australia ponders law after passive smoking trial. The Lancet 2001; 358:738.

Loff B, Durham H. Japan’s “comfort women”. The Lancet 2001; 357:302-303.

McConnell S, Horrocks M, Sinclair M, Fairley CK. Changes in the incidence ofgastroenteritis and the implementation of public water treatment. Int J Env Health Research2001; 11(4):299-303.

McNeil J, Peeters A, Liew D, Lim S and Vos T. A model for predicting the future incidence ofcoronary heart disease risk within percentiles of coronary heart disease risk. JCardiovascular Risk 2001;8(1): 31-37.

Marks GB, Abramson MJ. House dust mite avoidance: facts and fiction. Asthma 2001;13:10-13.

Martin J, Krum H. Eplerenone. Current Opinion in Investigational Drugs 2001;2(4);521-524.

Martin J, Krum H. The Heart Failure Journal Club: a review of publications on heart failure inAmerican Heart Journal. European J of Heart Failure 2001;3:125-137.

Meyer A, Bernard S, Smith K, McNeil J. Asystolic cardiac arrest in Melbourne, Australia.Emergency Medicine, 2001;13:186-189.

Nelson M, Reid C, Krum H and McNeil J. A systematic review of subject baselinecharacteristics and study criteria as predictors of maintenance of Normotension afterwithdrawal of antihypertensive drugs. American Journal of Hypertension2001;14(2): 98-105.

Nelson MR, McNeil JJ, Peeters A, Reid CM, Krum H. PBS/RPBS cost implications oftrends and guideline recommendations in the pharmacological management of hypertensionin Australia, 1994-1998. MJA, 2001;174(11):565-568.

Padiglione AA, Grabsch E, Wolfe R, Gibson K, Grayson L. The prevalence of fecalcolonization with VRE among residents of long-term-care facilities in Melbourne,Australia.Infect Control Hosp Epidemiol 2001;22:576-578.

Packer M, Coats, A, Fowler M, Katus H, Krum H, Mohacsi P et al. Effect of carvedilol onsurvival in severe chronic heart failure. New Engl J Med, 2001;344:1651-8.

Robman LD, Tikellis G, Garrett SKM, Harper CA, McNeil JJ, Taylor HR, McCarthy CA.Baseline opthalmic findings in the VECAT study. Aust & NZ J of Ophthalmology 2001.

Ruttenber A, McCrea J, Wade T, Schonbeck M, LaMontagne A, Van Dyke M, et al.Integrating workplace exposure databases for occupational medicine services andepidemiologic studies at a former nuclear weapons facility. Appl Occupational &Environmental Hygiene 2001;16(2): 192-200.

San Laureano JA, Briganti EM, Colville DJ. Number needed to treat: a useful new method ofassessing the magnitude of treatment effect and its application to the management ofdiabetic retinopathy. Aust & NZ J Opthalmology.

Smith KL, Peeters A, McNeil JJ. Results from the first 12 months of a fire first-responderprogram in Australia. Resuscitation, 2001;49:143-150.

Smith K, Rich D, Pinol J, Hankin J, McNeil J. Acceptance of a medical first-responder role

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by fire fighters. Resuscitation 2001; 51:33-38.

Stephenson H. Electronic prescribing in hospitals: the road ahead. Australian Prescriber2001;24:2-3.

Stuart RL, Bennett NJ, Forbes AB, Grayson ML, on behalf of the Melbourne MantouxStudy Group. Assessing the risk of tuberculosis infection among healthcare workers: theMelbourne Mantoux study. MJA 2001; 174(11):569-573.

Striujs PA, Smidt N, Arola H, van Dijk CN, Buchbinder R, Assendelft WJ. Orthotic devicesfor tennis elbow (Cochrane Review). Cochrane Database of Systematic Reviews,2001;2:CD001821.

Striujs PA, Smidt N, Arola H, van Dijk CN, Buchbinder R, Assendelft WJ. Orthotic devicesfor tennis elbow: a systemaic review. Br J Gen Pract 2001; 51:924-9.

Teede HJ, Dalais FS, Kotsopoulos D, Liang YL, Davis S, McGrath BP. Dietary soy hasboth beneficial and potentially adverse cardiovascular effects: A placebo-controlled study inmen and postmenopausal women. J Clin Endoc and Metabolism 2001;86:3053-3060.

Thrift AG, Dewey HM, Macdonnel RAL, McNeil JJ, Donnan GA. Incidence of the majorstroke subtypes: Initial findings from the North East Melbourne Stroke Incidence Study(NEMESIS). Stroke 2001:32:1732-1738.

Tikellis G, Robman LD, Harper CA, Garrett SKM, McNeil JJ, Taylor HR, McCarty CA. TheVECAT Study: Methodology and statistical power for measurement of age-related macularfeatures. Ophthalmic Epidemiology.

Tzanidis A, Lim S, Hannan RD, See F, Ugoni AM, Krum H. Combined angiotensin andendothelin receptor blockade attenuates adverse cardiac remodeling post-myocardialinfarction in the rat: Possible role of transforming growth factorbeta-1. J Mol Cell Cardiol, 2001;33:969-981.

Van Dyke M, LaMontagne A, Martyny J and Ruttenber A. Development of an exposuredatabase and surveillance system for use by practicing OSH professionals. AppliedOccupational & Environmental Hygiene 2001;16(2): 135-143.

Wilcox G, Archer PD, Bailey M, Dziukas L, Fee Lim C, Schneider H. Measurement ofcardiac troponin 1 levels in the emergency department: predictive value for cardiac and all-cause mortality. MJA. 2001;174:170-173.

Wluka AE, Davis SR, Bailey M, Stuckey SL, Cicuttini FM. Users of oestrogen replacementtherapy have more knee cartilage than non-users. Ann Rheum Dis 2001 Apr; 60(4):332-336.

Woods RK, Walters EH, Wharton C, Watson N, Abramson M. The rising prevalence ofasthma in young Melbourne adults is associated with improvement in treatment. AnnAllergy Asthma Immunol 2001;87:117-123.

Woods R, Abramson M, Bailey M, Walters EH. International prevalences of reported foodallergies and intolerances. European Resp J 2001; 55:298-304.

Woods RK. Food, food chemicals and asthma: how prevalent are they? Aust J Nutr Diet2001;58:198-199.

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